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Optimizing Warfarin Dose: Tools and Strategies for Today and Tomorrow
Warfarin (Coumadin®), the most widely prescribed oral anticoagulant, is one of the most difficult medications to manage due to a narrow therapeutic range and wide inter-individual variability in both response and pharmacokinetics. It has become evident that up to 70% of the variability in warfarin dosing can be accounted for by variation in two genes: CYP2C9, which is associated with warfarin inactivation, and VKORC1, which is associated with the mechanism of action for warfarin. In 2007 labeling information for warfarin was revised to include information about how genetic variants in CYP2C9 and VKORC1 impact warfarin dosing. This presentation provides an overview of key published literature surrounding warfarin dosing, provides case examples, reviews data generated in a study conducted at the University of Utah, and proposes new tools that may improve anticoagulation management for the future.
Originally presented December 18th, 2008 in Salt Lake City, Utah.
Lecture Presenter
Gwen McMillin, PhD, DABCC, FACB
Assistant Professor of Pathology, University of Utah Pathology
Medical Director, Toxicology, ARUP Laboratories
Dr. Gwen McMillin has been with ARUP Laboratories since 1996, and is currently the Medical Director of Toxicology as well as an Assistant Professor of Pathology at the University of Utah School of Medicine, in Salt Lake City, UT. She received a PhD in pharmacology, and post-doctoral training in clinical chemistry, at the University of Utah, and is nationally certified by the American Board of Clinical Chemistry in both Clinical Chemistry and Toxicological Chemistry. Dr. McMillin contributes to and serves as a reviewer for several professional journals, books and other publications, and actively participates in professional and scientific organizations.
Robert Pendleton, MD
Assistant Professor of Clinical Medicine, University of Utah School of Medicine
Co-Director, Hospitalist Program, University of Utah Medical Center
Director, University Healthcare Thrombosis Services
Robert (Bob) Pendleton, MD is Associate Professor of Medicine (clinical) in the General Internal Medicine Division at the University of Utah. He serves as both the Director of the University Healthcare Thrombosis Service and co-Director of the University Hospitalist program. His active clinical and research interests include the prevention and management of venous thromboembolism as well as improving the safety of anti-thrombotic therapy.
Objectives
After this presentation, attendees will be able to:
- Become familiar with clinical challenges of warfarin dosing
- Learn about laboratory and clinical tools available to guide selection of warfarin dose
- Understand strengths and limitations of algorithms designed to optimize warfarin dose through consideration of both clinical and laboratory data
Sponsored by:
University of Utah School of Medicine and ARUP Laboratories